To Proceed Via Telehealth or Not? Considerations for Pediatric Anxiety and Related Disorders Beyond COVID-19.

The COVID-19 pandemic accelerated a widespread shift to telehealth among mental health professionals to prioritize both providers' and clients' safety. Telehealth is likely here to stay; however, there is limited practical guidance for clinicians about how to make decisions regarding who should proceed with care via telehealth versus in-person. There also is virtually no data on the effectiveness of hybrid approaches to care; yet this can be an attractive option with potential clinical benefit. This paper provides practice-informed guidance to support shared clinical decision-making between clinicians and families to decide whether to engage in therapy services in-person or via telehealth. We specifically focus on decision-making guidance relevant for youth with anxiety or related disorders, given the unique implications of telehealth for these youth. Guided by the three-legged stool of evidence-based practice, we discuss how clinicians can use principles of shared decision-making to inform clinical recommendations about treatment modality.

Adapting psychotherapy in collaborative care for treating opioid use disorder and co-occurring psychiatric conditions in primary care.

INTRODUCTION: Opioid use disorder (OUD) and psychiatric conditions commonly co-occur yet are infrequently treated with evidence-based therapeutic approaches, resulting in poor outcomes. These conditions, separately, present challenges to treatment initiation, retention, and success. These challenges are compounded when individuals have OUD and psychiatric conditions. METHOD: Recognizing the complex needs of these individuals, gaps in care, and the potential for primary care to bridge these gaps, we developed a psychotherapy program that integrates brief, evidence-based psychotherapies for substance use, depression, and anxiety, building on traditional elements of the Collaborative Care Model (CoCM). In this article, we describe this psychotherapy program in a primary care setting as part of a compendium of collaborative services. RESULTS: Patients receive up to 12 sessions of evidence-based psychotherapy and case management based on a structured treatment manual that guides treatment via Motivational Enhancement; Cognitive Behavioral Therapies for depression, anxiety, and/or substance use disorder; and/or Behavioral Activation components. DISCUSSION: Novel, integrated treatments are needed to advance service delivery for individuals with OUD and psychiatric conditions and these programs must be rigorously evaluated. We describe our team's efforts to test our psychotherapy program in a large primary care network as part of an ongoing three-arm randomized controlled trial. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Testing a Theory of Implementation Leadership and Climate Across Autism Evidence-Based Interventions of Varying Complexity.

Prominent theories within the field of implementation science contend that organizational leaders can improve providers' fidelity to evidence-based practices (EBPs) by using focused implementation leadership behaviors that create an organizational climate for EBP implementation. However, this work has been criticized for overreliance on nonspecific, self-report fidelity measures and poor articulation of the boundary conditions that may attenuate leadership and climate's influence. This study tests the predictions of EBP implementation leadership and climate theory on observed fidelity to three school-based EBPs for autism that vary in complexity: pivotal response training (PRT), discrete trial training (DTT), and visual schedules (VS). Educators in kindergarten to third-grade autism support classrooms in 65 schools assessed their principals' EBP implementation leadership and school EBP implementation climate prior to the school year. Mid-school year, trained observers rated educator fidelity to all three interventions. Expert raters confirmed PRT was significantly more complex than DTT or VS using the Intervention Complexity Assessment Tool for Systematic Reviews. Linear regression analyses at the school level indicated principals' increased frequency of EBP implementation leadership predicted a higher school EBP implementation climate, which in turn predicted higher educator fidelity to PRT-however, there was no evidence of a relationship between implementation climate and fidelity to DTT or VS. Comparing principals whose EBP implementation leadership was ±1 SD from the mean, there was a significant indirect association of EBP implementation leadership with PRT fidelity through EBP implementation climate (d = 0.49, 95% CI [0.04, 0.93]). Strategies that target EBP implementation leadership and climate may support fidelity to complex behavioral interventions.

Review of Evidence-Based Strategies to Treat Alcohol Use Disorder.

Alcohol use disorder (AUD) is a serious, prevalent disorder that affects millions of people. There are numerous evidence-based treatments and strategies to treat AUD, but they are under-utilized for a variety of reasons, including provider stigma, lack of knowledge, lack of professional support, shortage of willing providers, and patient barriers. Disulfiram, naltrexone, and acamprosate are approved but underused medications for the treatment of AUD. Nonpharmacological strategies and treatments include the use of motivational interviewing when talking to patients about their alcohol use, peer support or mutual help groups, and individualized therapy. Nurses are in a prime position to educate themselves and patients on evidence-based treatments for AUD and to help patients access those treatments. [Journal of Psychosocial Nursing and Mental Health Services, 59(12), 7-11.].

Substance Use Withdrawal and Detox Strategies That Work.

Substance use disorders are considered chronic but treatable. The first step in recovery is going through withdrawal or detox from the substance used, which typically involves unpleasant physical and psychological symptoms. Some individuals are able and willing to enter inpatient facilities for withdrawal and detox. In some cases, outpatient withdrawal and detox programs are not available. Several barriers to treatment exist, including inability to pay, unavailability of programs, stigma, and co-occurring mental health disorders. During inpatient withdrawal and detox, patients are supported with medications. There is an underutilization of initiating medication that helps reduce substance use, such as naltrexone and suboxone, during inpatient withdrawal and detox. Many individuals opt or have no other choice but to go through withdrawal and detox on their own. Strategies include illicitly obtaining prescription medications for the symptoms and other measures, such as floating in the bathtub and exercise. Recovery from substance use can be facilitated by health care providers through use of harm reduction strategies, referrals to treatment, and prescribing medications when applicable. [Journal of Psychosocial Nursing and Mental Health Services, 59(9), 12-15.].

Profiles of Autonomic Activity in Autism Spectrum Disorder with and without Anxiety.

Both anxiety and autism spectrum disorder (ASD) are associated with atypical physiological activity. Few studies have systematically assessed the resting physiological activity in ASD with co-occurring anxiety disorders. We tested 75 participants divided in four groups: youth with ASD, with (ASD + Anxiety = 22, 6F, 12.29 ± 2.83 years old) and without co-occurring anxiety (ASD Alone = 15, 6F, 11.59 ± 2.85 years old) and compared their physiological profile with that of matched typically developing controls (TDC) with (Anxiety Alone = 16, 6F, 11.24 ± 3.36 years old) and without co-occurring anxiety disorders (TDC = 22, 8F, 11.88 ± 2.88 years old). Results indicated reduced sympathetic and parasympathetic activity at rest in ASD as compared to TDC youth. ASD + Anxiety and Anxiety Alone groups showed different sympathetic, but similar parasympathetic activity. These findings suggest that autonomic profile-based approaches may advance research, diagnosis, and treatment of ASD and anxiety.

Spirituality in Recovery From Substance Use Disorders.

Substance use disorders (SUDs) are chronic health disorders with exacerbation rates of approximately 50%. Spirituality has been identified as a factor that can improve recovery rates. Various definitions of spirituality exist that include concepts of finding meaning and connection in life and contact with the divine or something larger than ourselves. Patients generally want to include spirituality as part of their health care but barriers often exist for health care providers to address it, including lack of confidence, knowledge, and organizational support, and time constraints. Nursing programs lack content related to spirituality and should increase course content on this subject to improve comfort levels and competencies of nurses. Keeping in mind professional boundaries and respecting patients' individual differences, nurses have the potential to help patients in their recovery journey by facilitating discussion and growth in spirituality. Nurses can also advocate for their patients by including spiritual leaders in integrated health care teams. [Journal of Psychosocial Nursing and Mental Health Services, 58(9), 14-17.].

Self-Injury as an Addictive Disorder.

Self-injury is a mental health-related behavior people engage in to feel pain because they feel numb, to experience physical pain to ease their psychological pain, or to experience an emotional release. Self-injury is more common in patients with other co-occurring anxiety or mood disorders. An addictive component to self-injury has been identified related to an increase in dopamine levels from the self-injury, which then disrupts normal dopamine production similar to substance use disorders. Instruments are available to help identify patients who self-injure along with questions that should be asked in the course of a mental health assessment and physical examination. Patients with self-injury should be treated for any underlying mental health disorder as well as for self-injury, which includes therapy strategies and medications. Nurses can play a vital role in identifying and treating this disorder, which carries risk factors including infection, accidental death, and a higher risk of suicide. [Journal of Psychosocial Nursing and Mental Health Services, 58(6), 13-16.].

Therapy Strategies for Substance Use Disorders.

Substance use disorders (SUDs) are prevalent and carry a high mortality rate. SUDs are chronic health conditions resulting from a chemical imbalance in the brain. However, recovery from SUDs is possible. There are several evidence-based nonpharmacological therapies for SUDs, including cognitive-behavioral therapy, acceptance and commitment therapy, dialectical behavioral therapy, mindfulness-based interventions, and eye movement desensitization reprocessing. Many patients are not aware of, or do not receive, these therapies. Nurses can use simple strategies within the therapy models when working with patients with SUDs. In addition, nurses are in a prime position to educate patients about these evidence-based therapies and refer patients to therapists or advanced practice nurses with training and expertise in these nonpharmacological treatments. [Journal of Psychosocial Nursing and Mental Health Services, 58(3), 14-18.].

Fighting the Battle of Recovery Together: A Content Analysis of Anonymous Posts in an Online Substance Use Forum.

Background: The rates of use of substance have increased dramatically worldwide in the past several years. Approximately 10% of people who use illicit substances will develop a substance use disorder (SUD), which is a major health problem internationally. Recovery is a period of time when someone with an SUD is in remission or is not using substances. Little research has been done to examine views of patients with SUDs on recovery, particularly when that information is being shared anonymously.Objective: The purpose of the study is to gain an understanding of the experience of recovery from anonymous online postings in recovery support forums.Design: The study was conducted using a qualitative, descriptive, thematic content analysis approach to analyze 1,230 anonymous posts made to an International online recovery forum.Results: Themes identified from the online postings were that the experience of recovery included (a) the agony of withdrawal and screaming cravings, (b) a psychological roller coaster during withdrawal and recovery, and (c) use of coping skills and other strategies that help in recovery.Conclusions: These findings support current recommendations being given by healthcare providers on the use of coping skills and other recovery strategies. They also suggest that people with SUDs endure physical and psychological suffering and show a level of sophistication in managing their symptoms during recovery. Findings reveal that hope and feelings of self-satisfaction exist as a positive experience of recovery. Finally, we can interpret that there are clear benefits to online recovery communities and that healthcare providers have an important role to play as allies in the recovery experience.

Effective Strategies for Working With Patients With Substance Use Disorders.

Substance use is at epidemic proportions in the United States. Substance use disorders (SUDs) are difficult to treat and considered to be chronic with a high mortality rate. Nurses are in a prime position to help patients with SUDs in a variety of settings, but they often lack knowledge about the disorder and the skills to provide effective care. The identification and treatment of co-occurring disorders, such as trauma, are important when providing care for patients with SUDs. Empathy and perspective taking were once thought to be helpful when working with patients, but evolving thought is that compassion is more effective as it involves feeling for, and not with, patients and includes taking action to help another. Harm reduction strategies, such as accepting people where they are, as well as the use of motivational interviewing strategies are also effective when working with patients with SUDs. Involving patients with SUDs in their treatment plans through shared decision making is also effective in building a therapeutic relationship and improves outcomes. [Journal of Psychosocial Nursing and Mental Health Services, 57(9), 11-15.].

Virtual Reality for Individuals With Substance Use Disorders.

Substance use disorders (SUDs) remain difficult to treat, with relapse rates averaging 50% despite available treatment. There is a need for new and novel treatment for treating SUDs. The use of virtual reality (VR) shows promising results as a strategy to help patients with SUDs manage cravings, say no to substance use, reduce stress and anxiety, treat pain, learn life skills, exercise, and use as a substitute for substance use. In VR, patients use a head-mounted device to experience computer-generated 360° simulated environments. Studies have shown that VR activates some of the same areas of the brain that substances activate. The science and technology of VR is evolving, resulting in more affordability, but the price is likely still a barrier for most treatment providers and patients. In addition, applications used to treat SUDs were developed for use in research and are not currently available for public use. More rigorous studies are needed to determine the effectiveness of VR as a treatment for SUDs. [Journal of Psychosocial Nursing and Mental Health Services, 57(6), 15-19.].

Managing Opioid Use in Orthopaedic Patients Through Harm Reduction Strategies.

Opioids are commonly prescribed in orthopaedics for acute or chronic pain for a variety of conditions, including injury, trauma, degenerative processes, and postsurgical. Patients who are taking opioids because of a substance use disorder (SUD) are also seen in orthopaedics. Patients who are prescribed opioids are at risk of developing an opioid use disorder (OUD). Ten percent of Americans will develop an SUD, which is considered a chronic medical condition that develops due to an imbalance in brain chemistry. In studies, orthopaedic surgeons have a high rate of prescribing opioids, but this rate is decreasing along with national average due to public and provider awareness of the opioid epidemic and professional recommendations. Despite the evidence of a neurobiological cause for SUDs, stigma toward patients with SUDs and a knowledge deficit are common among healthcare professionals, including orthopaedic nurses. A harm reduction approach when working with orthopaedic patients taking opioids either prescribed or used because of an OUD can be applied to reduce the problematic effects of opioids. Harm reduction strategies are supportive to the patient and include education and prevention, adopting evidence-based treatment and communication strategies, and the use of naloxone to prevent opioid overdose.

Teenagers and Cannabis Use: Why It's a Problem and What Can Be Done About It.

Teenagers' use of cannabis is a significant problem due to the known detrimental effects it has on the developing brain. Cannabis use in the teenage years is associated with a disruption to the brain's reward system, impaired memory and cognition, and the potential for structural brain changes. Smoking cannabis can have a negative impact on the pulmonary system because it is a respiratory irritant. Teenagers are increasingly using electronic cigarettes, or vaping, to administer cannabis, which delivers a higher concentration of its psychoactive properties. Teenagers are not recognizing the health or other risks of using cannabis, such as motor vehicle accidents. All teenagers should be screened for cannabis use, and education about cannabis use should be age-specific and start in elementary education and continue through high school. Nurses are in a prime position to provide up-to-date, evidence-based education to teenagers, parents, and other health care professionals about teenagers' use of cannabis. Additional measures that can affect cannabis use in teenagers are screening for other underlying mental health disorders; improving quality of life, self-efficacy, and spirituality; and providing teenagers with opportunities to naturally stimulate the brain's reward center. [Journal of Psychosocial Nursing and Mental Health Services, 57(3), 11-15.].

Complementary Alternative and Integrative Treatment for Substance Use Disorders.

Complementary alternative and integrative medicine (CAIM) modalities are increasingly sought after by patients with chronic health conditions such as substance use disorders (SUDs). Evidence suggests that CAIM interventions can improve symptoms commonly seen in patients with SUDs, such as stress, anxiety, depression, and pain. Mindfulness-based intervention (MBI), such as meditation, has proven effective for a variety of conditions, including SUDs. Other CAIM strategies, such as manipulative body practices and healing energy medicine techniques, are also showing some evidence of effectiveness. These methods center on the concept of restoring balance to energy fields or acupoints on the body, including chakras and meridians. Nurses are in an ideal position to educate, administer, and teach patients these CAIM methods to integrate with traditional medical care. Resources to learn CAIM methods can be accessed online, and specialized certification in this field is also available. [Journal of Psychosocial Nursing and Mental Health Services, 56(6), 16-21.].

Nurses With Substance Use Disorders: Where We Are and What Needs To Be Done.

Nurses have the same rate of substance use disorders (SUDs) as the general public. Management of nurses with SUDs is moving from being punitive, including public license suspension or revocation, to alternative-to-discipline (ATD) programs that focus on early intervention and non-punitive, confidential help, which often involve continued employment. These programs have good retention rates, and nurses who complete them have fewer criminal convictions and are able to retain their nursing licenses and maintain successful careers in nursing. Barriers to nurses receiving care for SUDs include wide variability in ATD programs, inconsistent funding for treatment, and lack of policies and support for nursing students. Recommendations include changes to nurse practice acts to make ATD programs more uniform, provide adequate funding for all nurses and nursing students, and allow nurses to seek and obtain care without disclosing directly to Boards of Nurses. Colleges of nursing should implement policies to encourage early identification and treatment in nursing students, including ATD and dismissal programs. [Journal of Psychosocial Nursing and Mental Health Services, 55(12), 11-14.].

The Role of Pleasure Neurobiology and Dopamine in Mental Health Disorders.

Recent evidence and research has demonstrated that the pleasure response and associated neurotransmitters and brain circuits play a significant role in substance use disorders (SUDs). It was thought that negative behaviors associated with SUDs resulted from negative choices, but it is now known that chemical changes in the brain drive those behaviors. Several mental health disorders (e.g., eating disorders, non-suicidal self-injury, compulsive sex behaviors, internet gaming, gambling) are also thought to involve those same pleasure responses, neurotransmitters, and brain regions. Studies have shown that the use of naltrexone, a dopamine antagonist, can reduce symptoms of these disorders. It is important for nurses to understand the underlying physiology of mental health disorders that are thought to have an addictive or craving component. This understanding can help reduce stigma. Educating patients about likely neurobiological causes for their disorders can also help reduce guilt and shame. Nurses should educate patients about these disorders and evidence-based treatments, including off-label use of naltrexone. [Journal of Psychosocial Nursing and Mental Health Services, 55(9), 17-21.].

Amygdala Volume Differences in Autism Spectrum Disorder Are Related to Anxiety.

Recent studies suggest that longstanding findings of abnormal amygdala morphology in ASD may be related to symptoms of anxiety. To test this hypothesis, fifty-three children with ASD (mean age = 11.9) underwent structural MRI and were divided into subgroups to compare those with at least one anxiety disorder diagnosis (n = 29) to those without (n = 24) and to a typically developing control group (TDC; n = 37). Groups were matched on age and intellectual level. The ASD and anxiety group showed decreased right amygdala volume (controlled for total brain volume) relative to ASD without anxiety (p = .04) and TDCs (p = .068). Results suggest that youth with ASD and co-occurring anxiety have a distinct neurodevelopmental trajectory.